附1 人类反应型态护理诊断
NANDA通过的以人类反应型态分类方法的128个护理诊断
(1)交换(Exchanging) 营养失调:高于机体需要量(Altered Nutrition:More Than Body Requirements) 营养失调:低于机体需要量(Altered Nutrition: less Than Body Requirements) 营养失调:潜在高于机体需要量(Altered Nutrition:Potential for More Than Body
Requirements) 有感染的危险(Risk for Infection) 有体温改变的危险(Risk for Altered Body Temperature) 体温过低(Hypothermia) 体温过高(Hyperthermia) 体温调节无效(Ineffective Thermoregulation) 反射失调(Dysre flexia) 便秘(Constipation) 感知性便秘(Perceived Constipation) 结肠性便秘(Colonic Constipation) 腹泻(Diarrhea) 大便失禁(Bowel Incontinence) 排尿异常(Altered Urinary Elimination) 压迫性尿失禁(Stress Incontinence) 反射性尿失禁(Reflex Incontinence) 急迫性尿失禁(Unge Incontinence) 功能性尿失禁(Functional Incontinence) 完全性尿失禁(Total Incontinence) 尿储留(Urinary Retentron) 组织灌注量改变(肾、脑、心肺、胃肠、周围血管)(Altered Tissue Pefusion( Renal, Cereral, Cardiopulmonary Gastrointestinal,Peripheral)) 体液过多(Fluid Volume Excess) 体液不足(Fluid Volume Deficit) 体液不足的危险(Risk for Fluid Volume Deficit) 心输出量减少(Decreased Cardiac Output) 气体交换受损(Impaired Gas Exchanse) 清理呼吸道无效(Ineffective Airway Clearance) 低效性呼吸型态(Ineffective Breathing Pattern) 不能维持自主呼吸( Inability to Sustain Spontaneous Ventilation) 呼吸机依赖( Dysfunctional Ventilatory Weaning Response,DVWR) 有受伤的危险(Risk for Injury) 有窒息的危险(Risk for Suffocation)
有中毒的危险(Risk for poisoning) 有外伤的危险(Risk for Trauma) 有误吸的危险(Risk for Aspiration) 自我防护能力改变(Altered Protection)
有废用综合征的危险(Risk for di 组织完整性受损(Impaired Tissue Integrity) 口腔粘膜改变(Altered Oral Mucous Membrane) 皮肤完整性受损(Impaired Skin Integrity) 有皮肤完整性受损的危险(Risk for Impaired Skin Integrity) 调节颅内压能力下降( Decreased Adaptive Capacity Intracranial) 精力困扰(Energy Field Disturbance) (2)沟通(Communicating) 语言沟通障碍(impaired Verbal Communication) (3)关系(Relating) 社交障碍(Impaired Social Interaction) 社交孤立(Social Isolation) 有孤立的危险(Risk for Loneliness。) 角色紊乱(Altered Role Performance) 父母不称职(Altered Parenting) 有父母不称职的危险(Risk for Altered Parenting) 有父母亲子依恋改变的危险(Risk for Altered Parent/Infant/Child Att8Chffi6llt) 性功能障碍(Sexual Dysfunction) 家庭作用改变(Altered Family Process) 照顾者角色障碍(Caregiver Role Strain) 有照顾者角色障碍的危险(Risk for Caregiver Role Strain) 家庭作用改变:酗酒(Altered Family Process: Alcoholism) 父母角色冲突(Parental Role Conflict) 性生活型态改变(Altered Sexuality Patterns) (4)赋予价值(Valuing) 精神困扰(Spiritual Distress) 潜在的精神健康增强(Potential for Enhance Spiritual Well-Being) (5)选择(Choosing) 个人应对无效(Ineffective Individual Coping) 调节障碍(Impaired Adjustment) 防卫性应对(Defensive Coping) 防卫性否认(Ineffective Denial) 家庭应对无效:失去能力( Ineffective Family Coping:Disabling) 家庭应对无效:妥协性 (Ineffective Family Coping:Compromised) 潜在的家庭应对增强(Family Coping Potential for Growth) 潜在的社区应对增强(Potential for Enhanced Community Coping) 社区应对无效(Ineffective Community Coping) 执行治疗方案无效(个人的)(Ineffective Management of Therapeutic Regimen)(Individual) 不合作(特定的)(Noncompliance)(Specify) 执行治疗方案无效(家庭的)(Ineffective Management of Therapeutic Regimen:( (Families) 执行治疗方案无效(社区的)(Ineffective Management of Therapeutic Regimen: Community) 执行治疗方案有效(个人的)(Effective Management of Therapeutic Regimen:Individual) 抉择冲突(特定的)(Decisional Conflict)(Specify) 寻求健康行为(特定的)(Health Seeking Behaviors)(Specify)
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